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Jean Hall - Assuming office as Council Member-- Date Received - STATEMENT OF ECONOMIC INTERESTS I ' I iye- X2'21'I .. COVER PAGE -- Please type or Print in Ink. - NAME OF FILER (LAST) FIRSTI - '°M,-- - -. - -_ r L/AGL ✓L�Aa% 1. Office, Agency, or Court Agency Name (Do not use acronyms) CI Tx 6F Ll OSE'rrl G —AD Division, Board, Department, District, if applicable Your Position Cov rJ5 cL — E — 12>&54, ii� If Thing for mulOple positiocs, list below or on an attachment. (Do not use acronyms) Agency. Position. 2. Jurisdiction Of Office (Check at least one box) ❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction) ❑ Multi-County 55 County of L 1104 R City of 'q n'3C4+✓i.� D C4 ❑ Other 3. Type of Statement (Check at least one box) F Annual: The period covered is January 1, 2013, through ❑ Leaving Office: Date LeftJJ December 31, 2013. (Check one) .or. The period covered Is through O The period covered Is January 1, 2013, through the data of December 31, 2013. leaving office. 1.� ,, ,, Assuming Office: Date assumed �y -rte O The period covered is —JJ trough the date of leaving office. ❑ Candidate: Election year and office sought, if different than Part 1 4. Schedule Summary Check applicable schedules or "Mono." ► Total number of pages including this cover page: r52�Schedule A-1 - Investments - schedule attached Schedule C - Income, Loans, d Business Posdions - schedule attached Schedule A -2 - Investments - schedule attached FI Schedule D - Income - G fts - schedule attached 14 Schedule B - Real Property - schedule attached ❑ Schedule E - Income - GiRS - Travel Payments - schedule attached -or. ❑ None - No repairable interests on any schedule 5. Verification MAILI NG ADDRESS STREET cllV STATE z CODE 19u.mre4 or Apil Addsus aecermem'ea- PuN4 wumwnc /ia.�eF✓iv& iD C/� '7)770 SIPM �. �/ALi -G- t'jL ✓D GAYT. ME TELEP6CNE NUMBER EMAILAGORE55I0P7;0NA_) (>zb)sGS—a -10 0 1 have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the bast of my knowledge the information contained herein and in any attached schedules is true and complete. I acknowledge this is a public document. I certify under penalty of perjury under the laws of the Stale of California that the foregoing is true and correct. Dale Signed _z3 Signal �+ (mmlb sh'en 71-71 du z gre9m rfVnAVtll FPPC Form 700 (2013/2014) FPPC Advice Email: adviceCDippc.ra.gov FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.8ov, SCHEDULE A -1 .. Investments Stocks, Bonds, and Other Interests Name (Ownership Interest is Less Than 10%) Do not attach brokerage or financial statements. NAME OF RUSINEBS ENTITY Ci 16lrle e 4- SAN/I c; GENERAL DESCRIPTION OF THIS BUSINESS CrfJ_S'Av,NGS- CW�LKiNG FAIR MARKET VALUE ❑ S2 000 - $10,000 ❑ $To 001 - $100.00[ x$1[11.001 - $1 coo coo ❑ over $1000, 000 NATURE OF INVESTMENT Stock ❑ Other <oescnne) E] Partnership 0Income Received of $0 $099 Q Income Received of 5500 Or More (Report cn Sne. C) IF APPLICABLE. LIST BATE. —JJ 13 �_J 13 ACQUIRED DISPOSED � NAME of BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINL55 C Al x�u 1 F"z; 1FFAIIR MARKET VALUE Icy $2,000 - $10000 ❑ $1a0o1 - $100000 ❑ $100 001 - 51000.[[0 ❑ over $1900000 NATURE OF INVESTMENT Stock ❑ OF Or TV ... Le) L] Partnership 0 reorM Received of $0- $699 0Income Received of $500 or More (Report no Scnemle O) IF APPLICABLE, LIST DATE'. � 1 13 —JJ 13 ACQUIRED DISPOSED NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE ❑$2,000 -$10 000 $10,001 $100000 ❑ $100001 - $1000000 ❑ Over $1 000,000 NATURE OFINVESTMENT Stock Other foeamed) Pa- trBohip (Income Received of $o - V99 Q Income Received Of 5500 Or More (Report On 9MeJU)e C) IF APPLICABLE LIST DATE'. 13 J� 13 ACQUIRED DISPOSED Comments: /0,' -r GENERAL DESCRIPTION OF THIS BUSINESS 0 b FAIR MARKET VALUE - Qj$2n00- $10,000 ❑$to 001 - $1011.000 Fsiro 001 - $t 000.000 ❑ Over $1000000 NATURE OF INVESTMENT L] Stack El Other hiss l PaM - 5699 ersM1ip O Income Received of $0 - 0 Income Received of EficO or Mare (Report on Scnaoule CI IF APPLICABLE. LIST DATE. JJ 13 JJ 13 ACQUIRED DISPOSED e NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE ❑ $z 000 $10,000 ❑ smool - $100,000 ❑ 9100001 - $100o 000 ❑ Over $1.900 occ 'NATURE OF INVESTMENT Stock Other lkccn e) PaMersM1ip D Income Received of $0 -$699 0 Income Received of $$00 or More (Reperl on Schetlole O) IF APPLICABLE. LIST DATE: 13 JJ 13 ACQUIRED DISPOSED GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE E] SO $10 , 000 ❑$to,001 - $100,000 ❑ sloo 001 - $1 000,00c ❑ Over $t 000 000 NATURE OF INVESTMENT L] Stack D Offer mssume, Partnership C) Income Received of $0 -5699 O Income Received of $500 or More RReport on Smemle CI IF APPLICABLE. LIST DATE'. 13 ACQUIRED DISPOSED FPPC Form 700 (2013/20141 FPPC Advice Email: advice @fppc.w.gov FPPCToll -Free Helpline :866 /275 -37]2 www.fppaw.gov SCHEDULE A -2 Investments, Income, and Assets of Business Entities /Trusts (Ownership Interest is 10% or Greater) -,is 9✓, m ysc.a i c. L -4V e kin s (Business Address Acceptame) Trust 0 M 2 ❑ Business SPUR, complete the box, tick, 9. Ad 2 MIT DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE IF APPLICABLE. LIST DATE'. ] $o -$'999 ]$2000 -$10 BOO J—/13 13 ]$to 001- $100000 ACQUIRED DISPOSED ] $100 Oat - $t coo Coo ACQUIRED DISPOSED ] ❑ Over $1000,000 ] NATURE OF INVESTMENT NATURE OF INVESTMENT ] Partmil ] Sole Proprietorship ] YOUR BUSINESS POSITION ]$o -$999 ]sio001 sirocco ] ssoo - si coo X OVER $too, 000 ] $1001 - $to,000 None Lumm, brie Box: ] INVESTMENT ❑ REAL PROPERTY Name of Business Entity. it Investment gt Assessors Parcel Number or Street Address of Reel Property Description of Business Acticiry u Chy or Other Precise Location 0' Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE' 11 $2000 - $10,000 ❑ $to, 001v $100000 J� 13 JJ 13 ]$100001 - $1.000.000 ACQUIRED DISPOSED ] Over $1.000000 NATURE OF INTEREST ] PropeM OWnershlplDeed of Trust ] Stock ] Partnership LaaseM1OIE ❑ Other Yrsreme ning ] Check box if additional schedules III investments Or real property are attached CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION AtlaEd (Business Address Accentahlef Check one ❑ Trust Be b 2 ❑ Business Entity, complete the box, then 90 to 2 GENERAL DESCRIPTION OF THIS BUSINESS FAIR MARKET VALUE IF APPLICABLE, LIST DATE. ] $o - $1,999 ] $2000 - $10 000 113 Q$to,001- $100,000 ACQUIRED DISPOSED ] stoo 001 - sl oo0,000 ] Over $1 000 Coo NATURE OF INVESTMENT ] Partnership ] Sale Proprietorship Q YOUR BUSINESS ] so - Bags ] $to,00l - $100c00 ] $soo - $1900 ] OVER $100,000 ] $1,001 - $to 000 NDne 4. INVESTMENTS AND INTERESTS IN REAL PROFERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST Check one box: ] INVESTMENT ] REA, PROPERTY Name or 9usmess Ems, it I,vestmant Q Assessors Parcel Number or Street Ad Tess or Real Property Descriptipn or Business Activity or Cry or Other Precise Location or Real Procerty FAIR MARKET VALUE IF APPLICABLE, LIST DATE. ] $2,oco - $10,000 ❑sio ocl - sirs coo 13 ❑ $100,001 - $1,000 COO ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ] Proper, Ownership /Used of Trust ] Stock ] Partnership ] Leaseholtl remalning ] Other vrs ] Check box d additional schedules re00fing Investments or real property are Cocked FPPC Form 700 (2013/2014) Son. A -2 FPPC Advice Email: advice @fppc.ca.gov FPPCToll -Free Helpline: 866 /275 -3772 wvaw.fppc.ca.gov SCHEDULE B Interests in Real Property (Including Rental Income) le ASSESSOR'S PARCEL NUMBER �b5"SN m�sca7EC,4t/�%C5� crrr �oS�nJt9l C j} FAIR MARKET VALUE IF APPLICABLE. LIST DATE. ❑ $2000 - $1 o,00n ❑ $19,901 - $too,o00 � � 13 �a100001 -$1000 Co. ACQUIRED DISPOSED ❑ over$1 090,900 NATURE OFINTEREST ❑ Ownershipmaed Of Tpet ❑ Easement ❑ Leaeehold ❑ The renamhg Omer IF RENTAL PROPERTY, GROSS INCOME RECEIVED ❑ $o - $499 ❑ $500 - $1 000 ❑ $t oft - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 SOURCES OF RENTAL INCOME: If you em A 1011. or greater interest, list the name of each tenant that is a single source of income of $10,000 or more. ❑ Nane CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS /"/FSA- rl�triA Cl(- FAIR MARKET VALUE IF APPLICABLE, LIST DATE'. ❑$2,000 - $10900 O ag ❑ $t0 ,a01 - $100000 J� = --j--j-13 �5109,001 $1000009 ACQUIRED DISPOSED OVer $t099,000 NATURE OF INTEREST ❑ owner :h,eUem of Thal ❑ E. -nalot ❑ Leasehold ❑ Its reran., Omer IF RENTAL PROPERTY GROSS INCOME RECEIVED ❑ $0 $499 ❑ $500 - $1000 9 $1001 - $to, 000 ❑ $t0,001 - $100000 ❑ OVER 5100000 SOURCES OF RENTAL INCOME. If you awn a 10% or greater interest, list the name of each tenant that is a single source of income of $10,000 or more ❑ None You are not required to report loans from commercial lending institutions made in the lender's regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender's regular course of business must be disclosed as follows: NAME OF LENDER' ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY, IF ANY, INTCREST RATE TERM fMontheNears) ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑$500 -$1000 ❑$1501 -$to, 000 ❑ $10,001 - $100. Boo ❑ OVER $100000 ❑ Guarantor, P applicable Comments NAME OF LENOER' ADDRESS fBP.Pess Address Accepbmh ) BUSINESS ACTIVITY, IF ANY OF INTEREST RATE TERM Months/Years) k ❑ None HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1000 ❑ $1091 - $10000 ❑ $10,001 - $100,900 ❑ OVER $100,000 ❑ Guarantor, d applicable FPPC Form 700 (2013/2014) Son. B FPPC Advice Email: advice @fppc.ca.gov FPPCToll -Free HelPline:866 /2]5 -3]]2 www.fppc.ca.gov SCHEDULE C Income, Loans, & Business Positions (Other than Gifts and Travel Payments) NAME OF SOURCE OF INC ME Cl7y CD osz�,w4,4o ADDRESS (Buvnep Adds AOCeplable) 193X I q Z ; , &01 /75 ; BUSINESS ACTIVITY IF ANY OF SOURCE YOUR BUSINESS POSITION �.PdGGii 4PIrn^11%S, eice GROSS INCOME RECEIVED r.6 ❑ S500 - $1 Iy 000 l-si 001 - $10.000 ❑ $10001 - $100000 ❑ OVER $100,000 CONSIDERATION FOR Pool INCOME WAS RECEIVED Salary ❑ Spouses or registered domestic partners Income ❑ Loan repayment ❑ carmersh, nd Lec"mpmly, re. oon, em) E] Co armorion or [_] Ron.[ lnaome, n.4 -11 marre 11$If F1Y Or mam El Other CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION NAME OF SOURCE OF INCOME ADDRESS (Business Address Acceptable) BUSINESS ACTIVITY IF ANY OF SOURCE .YOUR BUSINESS POSITION GROSS INCOME RECEIVED 7 $500 -$1000 ❑$1001 -$to 000 ❑$10001- $100000 ❑ OVER $100000 CONSIDERATION FOR WHIOH INCOME WAS RECEIVED L] Salary ❑ Spouses or registered domestic partners Income ❑ Loan repayment ❑ Partnership ❑ Sale of I Feel 'Upe, cm. 11 em, I]Oommeorino Rental l ncame. Ieil ­1 d$mVi or F] Other _- e You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a retail installment or credit card transaction, made in the lender's regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender's regular course of business must be disclosed as follows. NAME OF LENDER' AOORESS f8ms ss Address Acceptable) BUSINESS ACTIVITY IF ANY OF LENDER HIGHEST BALANCE DURING REPORTING PERIOD 71 s500 - $1000 LJ $1,001 - $10,000 ❑ $10.001 - $100000 71 J OVER $100,000 Comments: INTEREST RATE TERM (Monthsttears) TT None SECURITY FOR LOAN 0 None E] Personal residence El Real PoBS, $seat e0tlress E] Guarantor ❑ Omer Cy FPPC Form 700 (2013/2014) Sch. C FPPC Advice Email: advice @fppc.ca.go , FPPC Toll -Free Helpline :866 /275 -3772 www.fppc.ca.gov MANOR: .� city of 1psemead Pour I,,, o \I IN OR PRO IF \I: Wip,,er� "F��0.COC 'R4� 3339 E YALLEI R01; I II, ARD P.O RO %399 ROSTA11 An. CAL[FORSIA 91730 COI ACIL AIrDIRl:RS TGI FPHOSI[ (52fi) 469 -2 100 S'1o111 Azvema NJ aacane r CtaRI FAS (n26li07 -9'_18 SI,AC\ Ir January 27, 2014 Fair Political Practice Commission Attn: Elaine Anderson 428 J Street suite 620 Sacramento, CA 95814 Dear Mrs. Anderson, Enclosed is an Economic Interest form 700 for our newly appointed Rosemead Council Member Jean Hall. Should you have any questions, please feel free to contact the office of the City Clerk at (626)569 -2177. Thank You. Sincerely, V -Y� Ericka Hernandez Assistant to the City Clerk Enclosure: Original 700 Form